Southeast Orthopedic Specialists

Insurance

• Review insurance denials to determine and take the next appropriate action steps to receive payment from the payor
• Appeal claims that have been denied for no auth, medical necessity, etc.
• Verify receipt of claims with insurance plans to ensure timeliness of claims reimbursement
• Assume full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts
• Communicate with payors through phone calls, emails, and payor portals
• Process and take action on written correspondence from insurance payors
• Identify and trend reasons for claim denials
• Resolve claim discrepancies reported by patients and other clinical departments

Insurance Follow-Up Representative

Accounts Receivable

• Perform timely follow-up on outstanding insurance and patient accounts receivable
• Review accounts for unpaid claims, denials, underpayments, and outstanding balances
• Research and resolve billing and account discrepancies
• Communicate with insurance payers regarding claim status, denials, payments, and outstanding balances
• Work assigned billing and A/R work queues within established departmental timelines
• Follow up on denied and unpaid claims and take appropriate action to resolve outstanding balances
• Assist with patient account inquiries and resolve billing-related concerns
• Maintain accurate and thorough documentation of account activity and follow-up
• Research payer requirements and reimbursement guidelines as needed
• Identify and communicate recurring billing or reimbursement issues to leadership
• Maintain confidentiality when handling patient and financial information
• Meet established productivity, quality, and departmental expectations
• Perform other duties as assigned